膿性感染を伴う結核性荒蕪肺に対する術式選択

Thoracic Surgery for Tuberculous Destroyed Lung

国内における結核感染症は減少の一途をたどっているが，外国人労働者の移住増加による非結核性抗酸菌症（NTM）を含めた抗酸菌感染症の増加傾向を見逃すことはできない．また結核後遺症の荒蕪肺には，免疫力が低下する高齢者に難治性膿胸の合併を引き起こす症例を認める．有瘻性膿胸の場合，起因菌の消失後も無菌性排液や気漏が続き，治療に難渋することがある．

Destroyed lung is the condition without the normal lung organizations as a consequence of chronic infection for example tuberculosis. We report two cases of 72-year-old and 74-year-old men with completely tuberculous destroyed right lower lobe and right upper lobe secondary infections respectively. Each case had treated antibiotics and/or antimycotics and tube-drainage, however discharge from the destroyed lung could not be obliterated. Therefor the first case was performed right lower lobectomy＋ curettage＋right phrenic nerve interruption. And then the second case was performed right thoracoplasty without the first rib resection and bronchial occlusion with Endobronchial Watanabe Spigot （EWS）. Both cases are doing well without relapse and thoracogenic scoliosis.